Underage drinking can be risky. But do “half the kids who drink before the age of 18” develop alcohol dependence?
This claim was made on a street poster put up by the Association for Alcohol Responsibility and Education (Aware.org), a South African non-profit organisation.
Aware.org describes itself as “the alcohol industry’s response” to concerns about alcohol misuse and abuse. “Our members include leading manufacturers of alcoholic beverages, such as SAB, Distell, Diageo, KWV, DGB and many others,” it says on its website.
Is the claim based on solid research? We checked.
US research doesn’t support claim
Aware.org CEO Ingrid Louw told Africa Check the statistic was from an article on the Verywell Mind website. The article was based on 2008 research by the US-based National Institute on Alcohol Abuse and Alcoholism (NIAAA).
But the institute told us its research did not support Aware.org’s claim.
Dr Aaron White, senior scientific advisor to the NIAAA’s director, said the 2008 journal article found that “the prevalence of alcohol dependence was 9% for people who started drinking before the age of 15, 6.8% for people who started between 15 and 17, and 4.1% for people who started at 18+”.
If the claim were accurate, 50% of people who started drinking before 18 would be alcohol dependent, White said.
The article was based on two waves – from 2001 to 2002, and 2004 to 2005 – of the NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions. “The entire final sample of Wave I and II was 34,653 but the analyses in the paper were based on 22,316 people,” White said.
It was a US study, he said, so its findings could not be applied to the South African population.
Amount of alcohol consumed important
The researchers found that people who had started drinking before 15 were more than twice as likely (133% more likely) to develop alcohol dependence than those who had started at 18 or older. For the age group 15 to 17, it was 1.7 times as likely (70% more likely), White said.
But the relationship between the age at first drink and alcohol dependence “became much weaker” when the risk factors for alcohol dependence were taken into account. These factors include mental health conditions and a family history of alcoholism.
“After the adjustments, those who started drinking before the age of 15 were 1.4 times as likely (38% more likely) to develop dependence as those who started at 18+. Starting at 15 to 17 was no longer a risk factor for alcohol dependence compared to those who started at 18+.”
White said the research suggested that the amount of alcohol a young person consumed was “a more powerful predictor of developing alcohol dependence” than when they started drinking.
“After taking the amount of alcohol people reported drinking into account, the relationship between age of first drink and the risk of developing alcohol dependence… disappeared.”
|What is alcohol dependence?
“Clinical diagnosis of a problem with alcohol is based on criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM),” White explained.
The fourth version of the manual (DSM-IV) distinguished between alcohol abuse and alcohol dependence.
Alcohol dependence is more severe than alcohol abuse, said White. Dependence “is consistent with what people call ‘alcoholism’”.
“In general, alcohol abuse is characterised by hazardous alcohol use that interferes with responsibilities and causes interpersonal problems while dependence involves physical symptoms like tolerance and withdrawal.”
In the fifth version of the manual (DSM-V), alcohol abuse and alcohol dependence are viewed as a single disorder – alcohol use disorder.
No South African research
As the US study does not support the claim, we tried to find relevant South African research.
Africa Check asked 12 researchers who had studied alcohol use in South Africa if they knew of local studies on the link between underage drinking and alcohol dependence.
Neo Morojele, professor in the department of psychology at the University of Johannesburg, said studies that tracked people over time would be the best way to investigate the claim. “I am not aware of any relevant ones that have been done in South Africa.”
The claim was “unlikely to be true”, she said.
Dr Saiendhra Moodley, public health medicine specialist at the University of Pretoria, said the prevalence of underage drinking in South Africa – and World Health Organization (WHO) estimates of the prevalence of alcohol dependence – suggest the claim “cannot be true”.
“It is a risk factor but not to the extent suggested.”
The 2011 South African National Youth Risk Behaviour Survey found that 49% of Grade 8 to 11 pupils had used alcohol, and 32% had done so in the month before the survey.
But Prof Charles Parry, director of the Alcohol, Tobacco and Other Drug Research Unit at the Medical Research Council, said it was “too early to say” whether this data proves or disproves Aware.org’s claim. That’s because the claim doesn’t make it clear by when alcohol dependence would have developed. “One would have to follow up with the 49% for say 10, 20 or 30 years.”
The claim’s figure “seems rather high”, Parry added.
Adrie Vermeulen, national coordinator of the South African National Council on Alcoholism and Drug Dependency, was not aware of “any” South African studies “linking underage drinking with adult alcohol use disorder”.
Conclusion: Research doesn’t support claim that 50% of people who start drinking before 18 become alcohol dependent.
A South African non-profit organisation claimed that half the people who start drinking before 18 develop alcohol dependence.
The US research said to support the claim did not come to this conclusion. We could not find any South African study that supported the claim.
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